1
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Armston-Sheret E. Nourishing food, clean air and exercise: medical debates over environment and polar hygiene on Robert Falcon Scott's British National Antarctic expedition, 1901-1904. Med Hist 2024:1-17. [PMID: 38497456 DOI: 10.1017/mdh.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The late nineteenth and early twentieth century saw dramatic new developments in climatic medicine, particularly the institutionalisation of thinking about tropical hygiene. There were also more limited efforts to understand how hygiene theories should be applied in a polar environment. Studying the British National Antarctic Expedition (1901-1904), led by Robert Falcon Scott, helps us understand how these practices had both similarities and differences from applications of hygiene in other contexts. The expedition offers unique insights into debates about hygiene, environment, and health because of the important, and well documented, role that medics, naval officers and scientists played in organising logistical arrangements for the journey to Antarctica. In analysing the writings of expedition members and organisers, this paper examines the ways that the universal tools of hygiene theories were applied and developed in a polar environment. Many of the most acute threats seemed to come not from the outside environment but from the explorers' supplies and equipment. There was general agreement on many issues. Yet the expedition's organisers, medics and leadership had numerous arguments about the best way to preserve or restore health. These disagreements were the product of both competing medical theories about the cause of disease and the importance of embodied (and somewhat subjective) observations in establishing the safety of foods, atmospheres and environments in this period.
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Affiliation(s)
- Edward Armston-Sheret
- Institute of Historical Research, School of Advanced Studies, University of London, Senate House Malet Street, London, WC1E 7HUUnited Kingdom
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2
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Kang W, Zong Y, Patel DA, Mishra T, Afonso L. An Unusual Etiology of Severe Right Heart Failure Deserving of Wider Recognition. JACC Case Rep 2024; 29:102222. [PMID: 38464798 PMCID: PMC10920146 DOI: 10.1016/j.jaccas.2024.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 03/12/2024]
Abstract
A previously healthy 31-year-old man presented with worsening shortness of breath and a petechial rash. Echocardiography showed severe right-sided heart failure with midsystolic notching of the antegrade right ventricular outflow Doppler envelope suggesting pulmonary hypertension. An extensive work-up revealed scurvy, with a dramatic resolution of symptoms shortly after vitamin C supplementation.
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Affiliation(s)
- Woosun Kang
- Department of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Yu Zong
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | | | - Tushar Mishra
- Department of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Luis Afonso
- Department of Cardiology, Wayne State University, Detroit, Michigan, USA
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3
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Verma KK, Deligonul FZ, Chen H, Tarbox M. Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn's Disease. Cureus 2024; 16:e55295. [PMID: 38558699 PMCID: PMC10981781 DOI: 10.7759/cureus.55295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
This case study features a 40-year-old male with Crohn's disease (CD) who was initially misdiagnosed with vasculitis but was later shown to have scurvy owing to vitamin C deficiency. The patient's diet was nearly exclusively made up of highly processed fast food, with no fresh fruits or vegetables. A mildly sensitive, violaceous rash on his lower legs, mild gingival hemorrhage and enlargement, and muscle soreness were among his symptoms. Anemia and undetectable vitamin C levels were discovered in laboratory studies. A skin sample revealed follicular hyperkeratosis, coiled hairs, and perifollicular bleeding, eliminating the possibility of vasculitis. Scurvy was confirmed by undetectable vitamin C levels and intramuscular bleeding discovered during a muscle biopsy. After one month of vitamin C administration, the patient's skin was entirely clear. This instance emphasizes the significance of taking vitamin C insufficiency into account in patients with CD and other disorders that can cause malabsorption. Misdiagnosis might result in unneeded treatments and medical expenses. Scurvy must be diagnosed as soon as possible because it might cause gastrointestinal/intracerebral hemorrhage and death.
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Affiliation(s)
- Kritin K Verma
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Fatma Z Deligonul
- School of Osteopathic Medicine, University of Incarnate Word, San Antonio, USA
| | - Helen Chen
- Dermatology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Michelle Tarbox
- Dermatology, Texas Tech University Health Sciences Center, Lubbock, USA
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4
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Masuda Y, Saigusa K, Norisue Y. A Case of Scurvy Associated With Intracerebral Hemorrhage in a Patient With Alcohol Use Disorder. Cureus 2024; 16:e54777. [PMID: 38523974 PMCID: PMC10961150 DOI: 10.7759/cureus.54777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Vitamin C deficiency, also known as scurvy, causes abnormalities in connective tissues and varied symptoms. We describe a patient with putaminal hemorrhage, a very rare presentation of scurvy. A 39-year-old man presented with weakness in the left arm and left leg. Right putaminal hemorrhage was initially diagnosed, and he underwent evacuation of the intracerebral hemorrhage. Scurvy was suspected when repeated physical examinations revealed a bleeding tendency and multiple untreated dental caries, missing teeth, and gingivitis. A diagnosis of scurvy was further supported by the patient's history of smoking, alcohol use disorder, poor diet, and low plasma vitamin C concentration. After receiving oral nutritional supplementation including vitamin C, the bleeding tendency quickly improved. This case highlights the importance of including scurvy in a differential diagnosis for patients with bleeding tendencies, especially those with a poor diet or unknown dietary history. Empirical administration of vitamin C is a reasonable treatment.
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Affiliation(s)
- Yohei Masuda
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Kuniyasu Saigusa
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
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5
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Appiah MM, Bohrer N, Galati A, Vuong C, Tucker SM, Hightower G. Vitamin C deficiency presenting as pseudoscleroderma in a pediatric patient with food aversion. JAAD Case Rep 2024; 44:82-84. [PMID: 38304101 PMCID: PMC10831238 DOI: 10.1016/j.jdcr.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Margaret M. Appiah
- Department of Dermatology, University of Washington Medicine, Seattle, Washington
| | - Nicholas Bohrer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Aidan Galati
- School of Medicine, University of California San Diego, San Diego, California
| | - Carrie Vuong
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Suzanne M. Tucker
- Department of Pathology, Rady Children's Hospital, San Diego, California
| | - George Hightower
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
- Department of Dermatology, University of California San Diego, San Diego, California
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6
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Solis WG, Taylor MA, Brooks M, Shaw R, Van Gelder EM, Van Gelder J. Ascorbic acid deficiency amongst spondylodiscitis patients. ANZ J Surg 2024; 94:229-233. [PMID: 38291316 DOI: 10.1111/ans.18845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Spondylodiscitis can be a disabling and life-threatening infection. Ascorbic Acid is crucial for neutrophil function and collagen formation. Its association and clinical relevance in spondylodiscitis has not been previously examined. AIMS To determine the prevalence, characteristics, and clinical outcomes of spondylodiscitis patients with Ascorbic Acid deficiency. METHODS Sixty-eight consecutive patients admitted with spondylodiscitis, between December 2021 and August 2023 were included. Clinical characteristics, Ascorbic Acid levels and clinical outcomes were evaluated. RESULTS Thirty-seven patients had Ascorbic Acid levels taken during admission. The median initial Ascorbic Acid level was 15 μmol/L with an IQR 6.5-27 μmol/L. Depletion defined as <28 μmol/L was present in 78% of patients. Deficiency defined as ≤11 μmol/L was present in and 46% of patients. Patients with depletion were more likely to require Intensive Care Admission (absolute risk increase = 24.1%; 2.6%-45.7%). Fifteen patients had repeat serum levels taken during admission with median increase of 17 μmol/L and an IQR 0-26 μmol/L. Patients that received supplementation had a significantly greater increase in Ascorbic Acid levels compared with those that did not receive supplementation (P = 0.002). CONCLUSION Ascorbic acid deficiency is highly prevalent amongst spondylodiscitis patients. Depletion was associated with worse outcomes. Replacement significantly increased serum levels in comparison to standard hospital diet. The clinical significance of replacement remains to be evaluated.
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Affiliation(s)
- Waldo Gerard Solis
- Department of Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
- Department of Neurosurgery, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Michael Brooks
- Department of Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Richard Shaw
- Department of Neurosurgery, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - James Van Gelder
- Department of Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
- South West Sydney Clinical Campuses, University New South Wales, Liverpool, New South Wales, Australia
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
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7
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Premkumar V, Jadhav R, Malwade S, Kale S. Severe Acute Malnutrition Presenting With Scurvy: A Case Report. Cureus 2024; 16:e54506. [PMID: 38516488 PMCID: PMC10955419 DOI: 10.7759/cureus.54506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Scurvy is a disease caused by a lack of vitamin C. It is a nutritional deficiency that is associated with multiple severe conditions. Although developed countries report these cases rarely now due to advancements in food and nutritional supplements, they are still prevalent in developing countries, albeit rare, because of poor nutritional status. Due to the lower prevalence of scurvy, diagnosis is delayed in the majority of cases and sometimes missed completely, which results in serious complications and unnecessary workups. Here, we present a rare case of a four-year-old female child with severe acute malnutrition (SAM) presenting with scurvy. The initial clinical signs showed SAM. X-ray and MRI of the left femur and knee were done to further evaluate the orthopedic parameters. Clinical presentation and radiographic imaging confirmed all the signs of scurvy. The patient was started on the Formula 75 (F-75) diet to address the severe malnutrition, and steady weight gain was observed.
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Affiliation(s)
- Varsha Premkumar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Renuka Jadhav
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Shivani Kale
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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8
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DeSena G, Yi L, Singh A, Sande M, Bryer B. A 12-year-old boy with petechiae, arthralgias, and muscle weakness. Pediatr Dermatol 2024. [PMID: 38291991 DOI: 10.1111/pde.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Grace DeSena
- University of Florida College of Medicine, Florida, USA
| | - Lauren Yi
- Department of Dermatology, University of Virginia, Virginia, USA
| | - Amrit Singh
- Department of Pathology, University of Virginia, Virginia, USA
| | - Margaret Sande
- Department of Emergency Medicine, University of Virginia, Virginia, USA
| | - Bridget Bryer
- Department of Dermatology, University of Virginia, Virginia, USA
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9
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Golder JE, Bauer JD, Barker LA, Lemoh CN, Gibson SJ, Davidson ZE. Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review. Nutr Rev 2024:nuad157. [PMID: 38219216 DOI: 10.1093/nutrit/nuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).
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Affiliation(s)
- Janet E Golder
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Nutrition and Dietetics Department, Allied Health, Monash Health, Melbourne, Victoria, Australia
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa A Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher N Lemoh
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne, Victoria, Australia
| | - Simone J Gibson
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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10
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Quigley C, Yhoo H, Victory L, Bowe S, Devenney C, Shudell E. A Case Series of Scurvy Presenting as Bruising. Dermatol Pract Concept 2024; 14:dpc.1401a30. [PMID: 38364389 PMCID: PMC10868954 DOI: 10.5826/dpc.1401a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 02/18/2024] Open
Affiliation(s)
| | - Helena Yhoo
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - Liana Victory
- Mater Misercordiae University Hospital, Dublin, Ireland
| | | | | | - Emma Shudell
- Mater Misercordiae University Hospital, Dublin, Ireland
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11
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Patel A, Vagha JD, Meshram RJ, Khandelwal R. A Rare Case of a Subgaleal Hematoma With Global Developmental Delay, Scurvy, and Congenital Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex, and HIV (TORCH) Infection. Cureus 2024; 16:e52211. [PMID: 38348003 PMCID: PMC10859727 DOI: 10.7759/cureus.52211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
This case report details the complex presentation of a six-year-old female child with global developmental delay (GDD), scurvy, congenital toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV (TORCH) infection and a subgaleal hematoma. The patient's medical history included delayed developmental milestones, bilateral congenital cataract, and a previous generalized tonic-clonic seizure. Thorough investigations revealed cerebral atrophy, bilateral ventricular dilatation, and periosteal thinning consistent with scurvy. The interdisciplinary approach involving neurology, ophthalmology, and orthopedics resolved the subgaleal hematoma. This case underscores the intricate interplay of neurological, nutritional, and infectious factors in pediatric conditions and highlights the importance of a collaborative, multidisciplinary approach for accurate diagnosis and effective management.
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Affiliation(s)
- Ankita Patel
- Pediatrics, Jawaharlal Nehru Medical College, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Wardha, IND
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12
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Haile A, Mara S, Belete Y, Dejene T. The Forgotten Disease in the 21st Century: Scurvy Outbreak in Hawassa Central Prison, Hawassa, Sidama, Southern Ethiopia, 2023. Int Med Case Rep J 2023; 16:847-866. [PMID: 38116464 PMCID: PMC10729832 DOI: 10.2147/imcrj.s438833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
Background Dietary deficiencies in vitamin C lead to scurvy, an uncommon disease of nutritional deficiency in contemporary clinical practice. The inability of humans to synthesize vitamin C necessitates the regular consumption of vitamin C containing fruits, vegetables, or tablets. Objective To report a series of cases that came to HUCSH from May 25th up to the 18th of July, 2023, and to describe clinical features of scurvy from an observational study of on-site prison investigation. Methods A descriptive analysis of a case series of ten patients admitted to HUCSH between May 25th and July 18th, 2023, and on-site observational study of 67 patients over one month. A structured questionnaire was used to collect data, and SPSS version 25 was used for analysis. Results From the case series, all of the ten patients had either unilateral or bilateral leg swelling or pain as common compliant and all of them were male prisoners with mean age of 25.6±5.33 years and following admission, the hemoglobin value increased to 7.1±1.34 g/dL with treatment from 4.6±1.88 g/dL. From observational study of the prison, 67 cases were identified based on unilateral or bilateral leg swelling and/or pain, which was the presenting feature in the cluster of cases seen at HUCSH. The mean age was 23.57±6.4 years, and each patient got therapeutic doses of ascorbic acid 500mg PO daily using directly observed therapy and follow-up visit was after two and four weeks of ascorbic acid initiation and all patients showed significant improvement. Conclusion For clinicians in modern medicine, there should be a high index of suspicion for scurvy as a possible differential diagnosis when a patient presents with leg swelling in high-risk population, such as prisoners. Health-care providers in prison clinics need to be alert to such forgotten yet life-costly disease in resource constrained prison clinics.
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Affiliation(s)
- Ashagrachew Haile
- Department of Internal Medicine, College of Medicine and Other Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Simeon Mara
- Department of Internal Medicine, College of Medicine and Other Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yegzeru Belete
- School of Medicine, College of Medicine and other Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tesfa Dejene
- School of Medicine, College of Medicine and other Health Sciences, Hawassa University, Hawassa, Ethiopia
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13
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Lu RL, Guo JW, Sun BD, Chen YL, Liu DZ. Scurvy in a young man: a rare case report. Front Nutr 2023; 10:1265334. [PMID: 37915623 PMCID: PMC10616463 DOI: 10.3389/fnut.2023.1265334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Scurvy, resulting from vitamin C deficiency, has nonspecific constitutional symptoms, including weakness, malaise, and fatigue. It is frequently misdiagnosed due to the lack of specific clinical manifestations. Although there are sporadic cases of scurvy currently reported in children, scurvy in young people is seldom encountered. Here, we report on a 25-year-old male patient without any underlying conditions who presented with severe pain and ecchymoses of both lower extremities. He was diagnosed with scurvy due to a long history of staying indoors and inadequate intake of fruits or vegetables.
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Affiliation(s)
- Rui-Ling Lu
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
| | - Jie-Wen Guo
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
| | - Bao-dong Sun
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
| | - Yu-Lan Chen
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
| | - Dong-Zhou Liu
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
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14
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Robin CJ, Robin KJ, Maier MA, Stevens ES. A Rare Presentation of Scurvy in a Well-Nourished Patient. Cureus 2023; 15:e46379. [PMID: 37927702 PMCID: PMC10620061 DOI: 10.7759/cureus.46379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Vitamin C deficiency, otherwise known as scurvy, is a rare diagnosis among populations with adequate nutritional resources. We present a 37-year-old female patient with bilateral lower extremity edema, episodic anasarca, petechiae, and easy bruising who was diagnosed with scurvy. Given the clinical presentation, a broad differential was investigated with no findings suggestive of hematologic or cardiovascular pathology. Initial laboratory studies were unremarkable. Progression of cutaneous symptoms and subsequent laboratory findings demonstrating low vitamin C levels supported a diagnosis of scurvy. Classical symptoms of scurvy include mucocutaneous petechiae, poor wound healing, ecchymosis, hyperkeratosis, corkscrew hair, gingival swelling, and bleeding gums. Following standard enteral supplementation of vitamin C, repeat vitamin C levels failed to adequately respond with the patient remaining to be symptomatic. Given a lack of insufficient nutritional intake or known systemic illness, gastrointestinal malabsorptive etiology was suspected. Though rare in the United States, scurvy should be considered in patients with manifestations of a bleeding disorder. A gastrointestinal workup may be indicated if other nutritional deficiencies are identified, or a source of inadequate intake cannot be established.
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Affiliation(s)
- Connor J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Kaleb J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Mark A Maier
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Elyse S Stevens
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
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15
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de Freitas LJA, Camelo FS, Borges MJA, Gomes RGDA, de Almeida MM, da Silva DCS, Garcia MHDO, dos Santos ED. Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study. Epidemiol Serv Saude 2023; 32:e2022258. [PMID: 37729262 PMCID: PMC10510616 DOI: 10.1590/s2237-96222023000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023] Open
Abstract
MAIN RESULTS An outbreak of illness compatible with scurvy occurred among male prison inmates; most frequent signs/symptoms were edema and pain in lower limbs, difficulty in walking and hematoma/ecchymosis; the associated factor was age > 40 years. IMPLICATIONS FOR SERVICES The results can contribute to the identification and description of scurvy outbreaks in other contexts and territories. Epidemiological studies of events like this enhance the practice of field epidemiology in health services. PERSPECTIVES It is expected that the prevention of hypovitaminosis, such as scurvy, will be based on public policies aimed at the population deprived of liberty; and that the capabilities of health services to detect and respond to cases of the disease will be improved. OBJECTIVE to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. METHODS this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. RESULTS out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. CONCLUSION we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.
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Affiliation(s)
- Leonardo José Alves de Freitas
- Ministério da Saúde, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde, Brasília, DF, Brazil
| | - Fernanda Sindeaux Camelo
- Ministério da Saúde, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde, Brasília, DF, Brazil
| | | | | | | | | | | | - Elizabeth David dos Santos
- Ministério da Saúde, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Brasília, DF, Brazil
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da Silva NCXM, Caselli PFB, Marinho CP, Lopez LDG, Vasconcelos FM, Nauff MV, Gonçalves KC. Scurvy and food selectivity in childhood: a case report. Einstein (Sao Paulo) 2023; 21:eRC0356. [PMID: 37729311 PMCID: PMC10501761 DOI: 10.31744/einstein_journal/2023rc0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/31/2023] [Indexed: 09/22/2023] Open
Abstract
Despite its rarity, symptomatic micronutrient deficiency remains a public health problem. Scurvy is the differential diagnosis for bleeding disorders and hematological and rheumatological diseases, especially in patients with eating disorders. However, it is unrelated to autism spectrum disorders or other neurodevelopmental disorders. A previously healthy 10-year-old boy living in São Paulo, Brazil, had a history of significant food selectivity unrelated to autism spectrum disorder, resulting in symptomatic ascorbic acid deficiency (scurvy). This resulted in pain and purpuric lesions on the lower limbs, gingival edema, bleeding during tooth brushing, asthenia, weakness, malaise, and sadness. Therefore, dietary anamnesis is important for routine monitoring of child growth and development. This process helps prevent nutritional deficiencies, facilitates early diagnosis of eating disorders, and enables multidisciplinary follow-up for these patients.
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Affiliation(s)
- Nicole Carvalho Xavier Micheloni da Silva
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Paula Fraiman Blatyta Caselli
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Chahine Pereira Marinho
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Lucia Daihana Godoy Lopez
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Fernanda Menezes Vasconcelos
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mariana Vicentin Nauff
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Kamila Caixeta Gonçalves
- Hospital Municipal Dr. Moysés DeutschHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Abstract
Background: The discovery of vitamin C (ascorbic acid) is related to the ancient history of persistent research on the origins of the haemorrhagic disease scurvy. Vitamin C is an important nutrient that aids in a variety of biological and physiological processes. Scientists have been researching the function of vitamin C in the prevention and ailment of sepsis and pneumonia for decades. This has created a potential platform for applying these results to individuals suffering from severe coronavirus infection (COVID-19). Vitamin C's ability to activate and enhance the immune system makes it a promising treatment in the present COVID-19 pandemic. Vitamin C also aids in the activation of vitamin B, the production of certain neurotransmitters, and the transformation of cholesterol into bile acids. Hence, vitamin C is used for the treatment of many diseases. Aim: This review highlights the Vitamin C investigations that are performed by various researchers on patients with COVID 19 infection, the clinical studies and their observations. The authors have additionally updated information on the significance of vitamin C insufficiency, as well as its relevance and involvement in diseases such as cancer, wound healing, iron deficiency anaemia, atherosclerosis and neurodegenerative disorders. Here, we discuss them with the references. Methods: The method used in order to perform literature search was done using SciFinder, PubMed and ScienceDirect. Results: There is a potential role of vitamin C in various diseases including neurodegenerative disorders, COVID-19 and other diseases and the results are highlighted in the review with the help of clinical and preclinical data. Conclusion: More research on vitamin C and the undergoing clinical trials might prove a potential role of vitamin C in protecting the population from current COVID-19 pandemic.
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Affiliation(s)
- Nikhil Mehta
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
| | - Purvi Pokharna
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
| | - Saritha R Shetty
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
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18
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Joulal H, Yousfi J, Benjilali L, Zahlane M, Essaadouni L. Haemorrhagic Pericardial Effusion as the Presenting Symptom of Scurvy. Eur J Case Rep Intern Med 2023; 10:004026. [PMID: 37680776 PMCID: PMC10482132 DOI: 10.12890/2023_004026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Vitamin C deficiency (or scurvy) usually takes weeks to become apparent as cutaneous signs and impaired wound healing. Haemorrhagic pericarditis remains a rare complication of scurvy, which has never been reported as an isolated condition. We report the case of a haemorrhagic pericarditis revealing a vitamin C deficiency in a 56-year-old patient. Case description A 56-year-old woman presented with a 2-week history of worsening chest pain and dyspnoea, with no significant medical history. Upon admission, the patient exhibited tachycardia, tachypnoea, low blood pressure, elevated jugular venous pressure, muffled heart sounds and multiple petechiae on her lower limbs. An ultrasound revealed a large pericardial effusion, and an emergency pericardiocentesis was performed, which yielded haemorrhagic fluid without atypical cells. An initial workup including haemoculture, PT and PTT, tuberculosis workup, autoantibodies, tumour markers and infectious disease was negative. A whole-body CT scan showed no evidence of tuberculosis or lymphoma. Additional testing showed that her vitamin C level was <3 umol/L. Following stabilisation, high-dose vitamin C therapy was initiated. Subsequently, she showed continued clinical improvement and remained asymptomatic upon her discharge. Discussion While uncommon, it is crucial to investigate vitamin C deficiency when confronted with an unexplained haemorrhagic pericardial effusion, particularly in patients with risk factors. Conclusion Our case highlights the significance of early detection of this condition in promptly addressing the diverse complications of scurvy, thereby enhancing the prognosis of a potentially fatal condition. LEARNING POINTS Haemorrhagic pericarditis could be an initial indication of scurvy.Vitamin C deficiency must be included in the differential diagnostic of haemorrhagic tamponade, even in the absence of a typical signs and symptoms of scurvy.
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Affiliation(s)
- Hajar Joulal
- Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco
| | - Jaouad Yousfi
- Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco
| | - Laïla Benjilali
- Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco
| | - Mouna Zahlane
- Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco
| | - Lamiaa Essaadouni
- Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco
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19
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Hanania H, Maheshwari K, Dunn C, Rosen T. Early scurvy in the modern era: A case series. JAAD Case Rep 2023; 38:130-135. [PMID: 37521197 PMCID: PMC10382845 DOI: 10.1016/j.jdcr.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Hannah Hanania
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kush Maheshwari
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Carly Dunn
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Ted Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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20
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Pope M, Elder J. Scurvy: An elusive diagnosis. Clin Case Rep 2023; 11:e7418. [PMID: 37255614 PMCID: PMC10225610 DOI: 10.1002/ccr3.7418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/02/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
Key Clinical Message Scurvy is uncommon in the developed world, and clinical presentation may mimic other pathologic states. A thorough social and dietary history is essential to identifying patients at risk of vitamin C deficiency, which can then be easily treated. Abstract Scurvy is a disease of defective collagen synthesis that is characterized by easy bruising, gingival hemorrhages, poor wound healing, fatigue, and arthralgias. It is caused by dietary deficiency of vitamin C. This is the case of a patient with multiple risk factors for malnutrition who was diagnosed with scurvy.
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Affiliation(s)
- Michael Pope
- Department of Hospital MedicinePiedmont Hospital AugustaAugustaGeorgiaUSA
- Department of Internal MedicineAugusta University Medical CenterAugustaGeorgiaUSA
| | - Joshua Elder
- Department of Internal MedicineAugusta University Medical CenterAugustaGeorgiaUSA
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21
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Gandhi M, Elfeky O, Ertugrul H, Chela HK, Daglilar E. Scurvy: Rediscovering a Forgotten Disease. Diseases 2023; 11:78. [PMID: 37366866 DOI: 10.3390/diseases11020078] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a nutritional deficiency caused by low vitamin C levels that has been described since ancient times. It leads to a varied presentation, affecting multiple organ systems due to its role in the biochemical reactions of connective tissue synthesis. Common manifestations include gingival bleeding, arthralgias, skin discoloration, impaired wound healing, perifollicular hemorrhage, and ecchymoses. Although there has been a dramatic reduction in the prevalence of scurvy in modern times owing to vitamin C supplementation and intake, sporadic cases still occur. In developed countries, it is mainly diagnosed in the elderly and malnourished individuals and is associated with alcoholism, low socio-economic status, and poor dietary habits. Scurvy has been an unusual cause of gastrointestinal (GI) bleeding among other GI manifestations. It can be adequately treated and prevented via vitamin C supplementation.
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Affiliation(s)
- Mustafa Gandhi
- Department of Internal Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Omar Elfeky
- Department of Medicine, University of Florida, Leesburg, FL 32611, USA
| | - Hamza Ertugrul
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
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22
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Rakotoambinina B, Vagedes J. Editorial: Case reports in pediatric gastroenterology, hepatology and nutrition 2022. Front Pediatr 2023; 11:1206993. [PMID: 37303749 PMCID: PMC10249014 DOI: 10.3389/fped.2023.1206993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Benjamin Rakotoambinina
- Lab LRI Division of Isotopic Medicine, Pediatric and Adult Physiology, University of Antananarivo, Antananarivo, Madagascar
| | - Jan Vagedes
- ARCIM Institute, Department of Pediatrics,Filderklinik, University of Tübingen, Filderstadt, Germany
- ARCIM Institute, Department of Neonatology, Filderklinik, University of Tübingen, Filderstadt, Germany
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23
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Küçükçongar Yavaş A, Engin Erdal A, Çıtak Kurt AN, Kurt T, Cankurt İ, Ünal Uzun Ö. Difficult to think about but easy to treat: scurvy. J Pediatr Endocrinol Metab 2023; 0:jpem-2023-0129. [PMID: 37193674 DOI: 10.1515/jpem-2023-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Severe vitamin C deficiency, or scurvy, presents as a syndrome of multisystem abnormalities associated with defective collagen synthesis and antioxidative functions. The many clinical features of scurvy lead to frequent misdiagnoses, as they can often point to other diseases, such as vasculitis, venous thrombosis and musculoskeletal disorders. As such, an extensive workup is recommended in cases in which scurvy is suspected. CASE PRESENTATION A 21-month-old male patient and a 36-month-old female patient presented with difficulty in walking, painful joint movements, irritability, gingival hypertrophy and bleeding. After exhaustive investigations and risky invasive procedures, vitamin C deficiency was diagnosed in both cases, and the symptoms improved dramatically with vitamin C treatment. CONCLUSIONS The importance of taking a dietary history in pediatric patients is highly recommended. In cases where scurvy is considered, serum ascorbic acid levels should be checked to confirm the diagnosis prior to conducting invasive tests.
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Affiliation(s)
- Aynur Küçükçongar Yavaş
- Department of Pediatric Metabolic Diseases, Children's Hospital, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Ayşenur Engin Erdal
- Department of Pediatric Metabolic Diseases, Children's Hospital, Ankara Bilkent City Hospital, Çankaya, Ankara, Türkiye
| | - Ayşegül Neşe Çıtak Kurt
- Department of Pediatric Neurology Diseases, Children's Hospital, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Tuba Kurt
- Department of Pediatric Romatology Diseases, Children's Hospital, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - İlknur Cankurt
- Department of Pediatric Neurology Diseases, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Özlem Ünal Uzun
- Department of Pediatric Metabolic Diseases, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
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24
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Alhalabi R, Nasrallah B, Rahman R, Muad H, Qureshi A. Chronic Recurrent Multifocal Osteomyelitis Mimicking Scurvy in a Child: A Case Report. Cureus 2023; 15:e38880. [PMID: 37313111 PMCID: PMC10259692 DOI: 10.7759/cureus.38880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Scurvy is a rare clinical syndrome resulting from prolonged vitamin C deficiency and is uncommon in the Gulf area. It can present with non-specific symptoms, making diagnosis and treatment challenging. In pediatric patients, symptoms may include weight loss, lethargy, low-grade fever, anemia of varying degrees, easy bruising or bleeding, joint and muscle pain, and poor wound healing. Despite advances in healthcare in many Gulf countries, nutritional deficiencies can still occur in certain populations. Therefore, it is important for pediatricians, orthopedists, rheumatologists, and radiologists to consider scurvy in the evaluation of children with low-grade, multisystemic involvement. We report a case of a six-year-old boy who presented to the emergency department (ED) multiple times with progressive right (RT) leg pain. The clinical picture and imaging findings suggested chronic recurrent multifocal osteomyelitis (CRMO). Despite symptom progression, scurvy was ultimately diagnosed and treatment with vitamin C led to rapid resolution of his symptoms. This case highlights the importance of considering scurvy in the differential diagnosis of children with multisystemic involvement, especially in regions where nutritional deficiencies may be more prevalent.
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Affiliation(s)
- Rawan Alhalabi
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Basil Nasrallah
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Rizviya Rahman
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Hussein Muad
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Assad Qureshi
- Department of Orthopaedic Surgery, American Hospital Dubai, Dubai, ARE
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25
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Jafri A, Edwards O, Gupta P, Abdul-Aziz R. Scurvy in a Pediatric Patient Unable to Bear Weight: A Case Report. Cureus 2023; 15:e38687. [PMID: 37292550 PMCID: PMC10244491 DOI: 10.7759/cureus.38687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/10/2023] Open
Abstract
Pediatric scurvy is uncommon in the twenty-first century but cases have been reported in children with neurodevelopmental issues and restricted diets. We are reporting a two-year and nine-month-old boy who had a coronavirus disease (COVID) infection and then presented with a refusal to walk. By careful history-taking, he was found to have a restricted diet, speech delay, and gum bleeding suggestive of scurvy, which was confirmed by extremely low levels of ascorbic acid. In this case, the diagnosis of scurvy was established before establishing the diagnosis of neurodevelopmental delay. Treatment with ascorbic acid resulted in a remarkable improvement in his symptoms. This case highlights the importance of collecting a thorough history, connecting exam findings to the history, and including scurvy in differential diagnoses for the presentation of inability to bear weight.
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Affiliation(s)
- Aleena Jafri
- Pediatrics, State University of New York (SUNY) at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Olayinka Edwards
- Family Medicine, Jericho Road Community Health Center, Buffalo, USA
| | - Puneet Gupta
- Radiology, John R. Oishei Children's Hospital of Buffalo, Buffalo, USA
| | - Rabheh Abdul-Aziz
- Pediatric Rheumatology, State University of New York (SUNY) at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
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26
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Elouali A, El Haddar Z, Bouabdella Y, Rkain M, Babakhouya A. A Case of Scurvy in a Child: An Uncommon but Important Diagnosis to Consider. Cureus 2023; 15:e39369. [PMID: 37362528 PMCID: PMC10285571 DOI: 10.7759/cureus.39369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a rare disease resulting from a prolonged ascorbic acid deficiency. It commonly affects individuals with low incomes and limited access to fresh fruits and vegetables. The diagnosis of scurvy can be challenging for clinicians due to the non-specific symptoms, resulting in extensive investigations and a delayed diagnosis. We report the case of a 14-year-old girl who presented with symptoms of pallor, bone pain, inability to walk, petechiae, ecchymosis of the lower limbs, irritability, and swollen, bleeding gums. Initially, the symptoms raised suspicions of hematopoietic malignancies, such as leukemia, and the patient underwent a series of invasive diagnostic exams before arriving at the correct diagnosis. Following a detailed dietary anamnesis with the parents, it became evident that the patient had a limited intake of fresh fruits and vegetables. A vitamin C blood test confirmed the diagnosis of scurvy. The prompt resolution of the clinical symptoms after the administration of vitamin C provided further confirmation of the diagnosis. This case highlights the importance of considering a patient's medical history and symptoms rigorously to avoid unnecessary, expensive, and invasive medical procedures, as well as to prevent potential misdiagnosis.
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Affiliation(s)
- Aziza Elouali
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Zohair El Haddar
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Yasser Bouabdella
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Maria Rkain
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Abdeladim Babakhouya
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
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27
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Jones R, Shafiq L, Idowu B, Radhakrishnan NS, Fromm J. Abdominal Ecchymosis: Emergency, or Urgen-C? Cureus 2023; 15:e38091. [PMID: 37252579 PMCID: PMC10209748 DOI: 10.7759/cureus.38091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Scurvy is a multisystem disease caused by vitamin C deficiency, historically associated with lethargy, gingivitis, ecchymosis, edema, and death if left untreated. Contemporary socioeconomic risk factors for scurvy include smoking, alcohol abuse, fad diets, mental health conditions, social isolation, and economic marginalization. Food insecurity is also a risk factor. This report describes a case of a man in his 70s who presented with unexplained dyspnea, abdominal pain, and abdominal ecchymosis. His plasma vitamin C level was undetectable, and he improved with vitamin C supplementation. This case highlights the significance of awareness of these risk factors and emphasizes the need for a comprehensive social and dietary history to enable the timely treatment of this rare but potentially fatal disease.
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Affiliation(s)
- Riley Jones
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Leila Shafiq
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Benmichael Idowu
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | | | - Jason Fromm
- Medicine, University of Florida College of Medicine, Gainesville, USA
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28
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Powers CD, Sternberg MR, Patel SB, Pfeiffer CM, Storandt RJ, Schleicher RL. Vitamin C Status of US Adults Assessed as Part of the National Health and Nutrition Examination Survey Remained Unchanged between 2003-2006 and 2017-2018. J Appl Lab Med 2023; 8:272-284. [PMID: 36592081 PMCID: PMC10321475 DOI: 10.1093/jalm/jfac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND We compared serum vitamin C (VIC) status of the adult (≥20 y) US population in the National Health and Nutrition Examination Survey (NHANES) 2017-2018 with combined data from 2003-2004 and 2005-2006. METHODS VIC was measured using HPLC with electrochemical detection. Mean data were stratified by age, sex, race/Hispanic origin, income, body mass index, dietary intake, supplement use, and smoking status. Prevalence of VIC deficiency (<11.4 μmol/L) was calculated. RESULTS In NHANES 2017-2018, the mean VIC was 8 μmol/L higher in people ≥60 y compared with those 20-59 y of age, 10 μmol/L lower in men vs women, 8 μmol/L lower in low vs high income, 11 μmol/L lower in obese vs healthy weight, and 15 μmol/L lower in smokers vs nonsmokers. Differences in mean VIC across race/Hispanic origin groups ranged from 2 to 7 μmol/L. Mean VIC was 27 μmol/L higher with vitamin C-containing supplement use and positively associated (Spearman ρ = 0.33; P < 0.0001) with increasing dietary intake. The associations between mean VIC and the investigated covariates were generally consistent and the prevalence of deficiency was not significantly different between survey periods (6.8% vs 7.0%; P = 0.83). However, a few subgroups had double the risk. We found no significant survey differences in mean VIC (51.2 vs 54.0 μmol/L; P = 0.09). CONCLUSIONS Overall VIC status of the US adult population has remained stable since last assessed in the NHANES 2005-2006 survey. Vitamin C deficiency remained high for those with low dietary intake and who smoke.
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Affiliation(s)
| | | | - Sweta B Patel
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Renee J Storandt
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD
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Haider A, Gurjar H, Ghazanfar H, Singh H, Siddiqa A. A Reversible Cause of Cutaneous Rash in a Patient With Alcohol Consumption. Cureus 2023; 15:e35011. [PMID: 36938293 PMCID: PMC10021349 DOI: 10.7759/cureus.35011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
The most common cutaneous manifestations of alcoholism include urticarial reaction, flushing, porphyria cutanea tarda, psoriasis, rosacea, seborrheic dermatitis, and pruritus. Here, we present a case of a young male with a history of alcohol abuse who presented with non-blanching, petechial, and perifollicular macular rash secondary to vitamin C deficiency in view of poor oral intake. The rash improved significantly with vitamin C supplementation. Although rare in developed countries, clinicians should keep vitamin C deficiency as a differential diagnosis for skin rash in alcohol consumers.
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Affiliation(s)
- Asim Haider
- Internal Medicine, BronxCare Health System, New York, USA
| | - Hitesh Gurjar
- Internal Medicine, BronxCare Health System, New York, USA
| | | | | | - Ayesha Siddiqa
- Infectious Diseases, NewYork-Presbyterian Queens Hospital, New York, USA
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30
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Dresen E, Lee ZY, Hill A, Notz Q, Patel JJ, Stoppe C. History of scurvy and use of vitamin C in critical illness: A narrative review. Nutr Clin Pract 2023; 38:46-54. [PMID: 36156315 DOI: 10.1002/ncp.10914] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023] Open
Abstract
In 1747, an important milestone in the history of clinical research was set, as the Scottish surgeon James Lind conducted the first randomized controlled trial. Lind was interested in scurvy, a severe vitamin C deficiency which caused the death of thousands of British seamen. He found that a dietary intervention with oranges and lemons, which are rich in vitamin C by nature, was effective to recover from scurvy. Because of its antioxidative properties and involvement in many biochemical processes, the essential micronutrient vitamin C plays a key role in the human biology. Moreover, the use of vitamin C in critical illness-a condition also resulting in death of thousands in the 21st century-has gained increasing interest, as it may restore vascular responsiveness to vasoactive agents, ameliorate microcirculatory blood flow, preserve endothelial barriers, augment bacterial defense, and prevent apoptosis. Because of its redox potential and powerful antioxidant capacity, vitamin C represents an inexpensive and safe antioxidant, with the potential to modify the inflammatory cascade and improve clinical outcomes of critically ill patients. This narrative review aims to update and provide an overview on the role of vitamin C in the human biology and in critically ill patients, and to summarize current evidence on the use of vitamin C in diverse populations of critically ill patients, in specific focusing on patients with sepsis and coronavirus disease 2019.
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Affiliation(s)
- Ellen Dresen
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Zheng-Yii Lee
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aileen Hill
- Department of Anesthesiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Quirin Notz
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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31
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Erratum: Case Report: Uncommon cause of limp in the 21st century. Front Endocrinol (Lausanne) 2023; 14:1178917. [PMID: 37008905 PMCID: PMC10063206 DOI: 10.3389/fendo.2023.1178917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.968015.].
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32
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Huang C, Pickavance CL, Gawkrodger DJ. Skin disease and military conflicts: Lessons from the Crimean War (1854-56). J R Coll Physicians Edinb 2022; 52:336-340. [PMID: 36515578 DOI: 10.1177/14782715221139950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the Crimean War (1854-56), infamous for its high death rate from disease at 212 per thousand British troops annually - one third of which was due to cholera or dysentery - skin disease was common, accounting for 13% of all admissions and 4.2% of all deaths. Excluding typhus, skin disease caused 252 per thousand annual admissions and 8.8 per thousand annual deaths, with an overall case fatality of 3.4%. The commonest skin diseases were: localised cellulitis/abscess, ulcer, venereal disease, frostbite, scurvy, eruptive rashes and scabies. The biggest number of skin disease-related deaths were from frostbite and scurvy. Cutaneous afflictions with the highest case fatality were erysipelas (27%), gangrene (25%), smallpox (21%) and frostbite (19%). Problems from frostbite lessened during the better provisioned second winter. The experience of skin disease in the Crimea highlights the importance of public health and personal sanitation to skin health in the military context, and shows that skin-related infections and nutritional deficiencies easily develop if environmental conditions deteriorate.
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Affiliation(s)
- Chenghao Huang
- Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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33
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Muacevic A, Adler JR, Turney K, Driscoll M. Scurvy: A Diagnosis Not to Be Missed. Cureus 2022; 14:e33050. [PMID: 36721542 PMCID: PMC9881687 DOI: 10.7759/cureus.33050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Vitamin C deficiency, one of the oldest-known nutritional disorders, is now uncommon in high-income countries. Recently, however, there has been an increase in cases of vitamin C deficiency, also known as scurvy. We report three adult patients with histories of homelessness, food insecurity, and poor nutrition, making them particularly vulnerable to restrictive diets and at increased risk for scurvy. After proper diagnosis and treatment, favorable outcomes can be rapidly obtained. This case series emphasizes the importance of keeping a broad differential diagnosis and inquiring about nutritional history in patients presenting with purpura, gingival bleeding, and body hair changes.
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34
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Quinn LA, Gilley SP, Ta AD, Frank BS, Foley CB, Moore JM. Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy. Front Pediatr 2022; 10:1008507. [PMID: 36389378 PMCID: PMC9650637 DOI: 10.3389/fped.2022.1008507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.
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Affiliation(s)
- Laura A. Quinn
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stephanie P. Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Allison D. Ta
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Benjamin S. Frank
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Carolyn B. Foley
- Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jaime M. Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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35
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Hayashino K, Meguri Y, Komura A, Matsubara C, Shiraishi Y, Yoshida C, Yamamoto K, Imajo K. An Unbalanced Diet Limited to the Consumption of Boiled Vegetables Led to the Onset of Scurvy. Intern Med 2022; 61:1795-1798. [PMID: 34776483 PMCID: PMC9259325 DOI: 10.2169/internalmedicine.8122-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Scurvy is a rare disease caused by a vitamin C deficiency. Vitamin C is a water-soluble vitamin found in vegetables and fruits, but it is lost after boiling. A 59-year-old man presented with gingival pain after having a tooth extracted five years previously. Following the procedure, his diet comprised boiled vegetables to prevent pain. He then experienced bilateral lower leg pain, and computed tomography revealed intramuscular bleeding. His serum vitamin C level was below the detectable limit. His symptoms immediately improved with vitamin C administration. This case emphasized that consuming only boiled vegetables can lead to the onset of scurvy.
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Affiliation(s)
| | - Yusuke Meguri
- Department of Hematology, Okayama City Hospital, Japan
| | - Aya Komura
- Department of Hematology, Okayama City Hospital, Japan
| | | | | | | | | | - Kenji Imajo
- Department of Hematology, Okayama City Hospital, Japan
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36
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Rittatore MS, El Kik S, Ferrari MF, Krochik G, Casim D, Quatrone F. [ Scurvy in adolescence: case report]. ARCH ARGENT PEDIATR 2022; 120:e137-e141. [PMID: 35533127 DOI: 10.5546/aap.2022.e137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Scurvy is a disease caused by vitamin C deficiency. Although it is currently rare, risk groups in the pediatric population are described in the bibliography, including patients with eating disorders. We report the case of an 11-year-old male adolescent who developed the disease due to a selective eating habit, without fruits or vegetables. The objective of this report is to highlight the importance of complete food anamnesis in consultation with the health team, which allows to suspect and detect early and timely micronutrient deficiency disorders such as scurvy.
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Affiliation(s)
- M Sofía Rittatore
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Soraya El Kik
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela F Ferrari
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Krochik
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniel Casim
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fabiana Quatrone
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
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37
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Subhash S, Santosh ST. Scurvy in Children: The Silent Masquerader. J Trop Pediatr 2022; 68:6563640. [PMID: 35380727 DOI: 10.1093/tropej/fmac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In modern society, scurvy is well known in its historical perspective rather than clinical relevance. Scurvy is classically thought to manifest with signs of 'bleeding painful gums' in the undernourished. Little is known regarding its ability to mimic a wide range of rheumatological, orthopaedic, neurological and haematological illnesses. Due to the rarity of its occurrence, there is a poor understanding among present-day clinicians, and so scurvy can easily deceive the uninitiated. We report a school-aged boy with normal neurodevelopment who presented with lower limb pain and difficulty in walking. He was seen by multiple specialist doctors before the clinical diagnosis of scurvy was made by a general paediatrician. Investigations showed that this child had X-ray changes typical of scurvy with low serum ascorbic acid levels. On supplementation with vitamin C, he showed dramatic improvement in symptoms and gradually achieved complete recovery.
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Affiliation(s)
- Swathy Subhash
- Department of Paediatrics, KIMSHEALTH, Trivandrum, Kerala, India
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38
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Pallant A, Sullivan T, Kaluzny A. Nutritional deficiency presenting as acute pain, fatigue and bruising in a college health clinic. J Am Coll Health 2022; 70:670-672. [PMID: 32432971 DOI: 10.1080/07448481.2020.1767111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
A previously healthy university student presents to Health Services with sudden onset of pain, fatigue, bruising, and a rapidly progressive anemia. There was not any previous significant health history. The case discussion will emphasize the critical overlap of physical and mental health assessments in identifying the cause and cure of a potentially life-threatening health crisis for a young adult student.
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Affiliation(s)
- Adam Pallant
- Health Services, Brown University, Providence, Rhode Island, USA
| | - Tanya Sullivan
- Health Services, Brown University, Providence, Rhode Island, USA
| | - Andrew Kaluzny
- Health Services, Brown University, Providence, Rhode Island, USA
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39
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Abstract
Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-year-old boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal.
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Affiliation(s)
- Stephanie Thiemann
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Valeria Cimorelli
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia M. Bajwa
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, University of Geneva Faculty of Medicine, Geneva, Switzerland
- *Correspondence: Nadia M. Bajwa,
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40
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Masci D, Rubino C, Basile M, Indolfi G, Trapani S. When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital. Front Pediatr 2022; 10:981908. [PMID: 36186634 PMCID: PMC9519129 DOI: 10.3389/fped.2022.981908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The limping child frequently represents a diagnostic challenge. The differential diagnosis is broad and should include vitamin C deficiency. Scurvy, resulting from vitamin C deficiency, is the oldest-known nutritional disorder. Despite its rarity in developed countries, scurvy has been increasingly reported in recent years in pediatric patients, particularly those with autism or neurological disabilities. In the present retrospective study, we describe the clinical, laboratory, and radiological features of 8 patients diagnosed with scurvy in the Pediatrics Unit of Meyer Children's University Hospital, between January 2016 and December 2021. The majority (87%) were males, and the median age was 3.7 years. Half of the patients had comorbidities known to be risk factors for scurvy, while the remaining patients were previously healthy. All the children were admitted for musculoskeletal symptoms, ranging from lower limb pain (87%) to overt limping (87%). Mucocutaneous involvement was observed in 75% cases. Microcytic anemia and elevated inflammatory markers were common laboratory findings. Bone radiographs, performed on all patients, were often interpreted as normal at first, with osteopenia (62%) as the most frequent finding; notably, after re-examination, they were reported as consistent with scurvy in four patients. The most common magnetic resonance imaging findings were multifocal symmetrical increased signal on STIR sequence within metaphysis, with varying degrees of bone marrow enhancement, adjacent periosteal elevation and soft tissue swelling. Differential diagnosis was challenging and frequently required invasive diagnostic procedures like bone marrow biopsy, performed in the first three patients of our series. The median time frame between clinical onset and the final diagnosis was 35 days. Notably, the interval times between admission and diagnosis become progressively shorter during the study period, ranging from 44 to 2 days. Treatment with oral vitamin C led to improvement/resolution of symptoms in all cases. In conclusion, scurvy should be considered in the differential diagnosis in a limping child, performing a detailed dietary history and careful physical examination, looking for mucocutaneous lesions. A quick and correct diagnostic path avoids invasive diagnostic procedures and reduces the risk of long-term complications.
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Affiliation(s)
- Daniela Masci
- Post-graduate School of Pediatrics, University of Florence, Florence, Italy
| | - Chiara Rubino
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Massimo Basile
- Radiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Florence, Italy
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41
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Iamopas O, Ratanachu-Ek S, Kaewnimee S. Scurvy in children - A neglected disease? Pediatr Int 2022; 64:e15324. [PMID: 36331236 DOI: 10.1111/ped.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidences of pediatric scurvy has decreased substantially, particularly in developed countries, but there are still reports of it from developing countries. Unusual manifestations have led to delays in diagnosis and treatment. Nevertheless, there are few publications regarding misdiagnosis of scurvy. The objective is to determine dietary factors, clinical manifestations, laboratory and radiologic findings, treatment, and outcomes of scurvy cases. The occurrence of misdiagnosis and its associated factors are also explored. METHOD The medical records of 0-18 year-old children from 2003 to 2016, diagnosed with scurvy, were included and reviewed. Clinical data, and data regarding feeding history, nutritional status, laboratory and radiologic findings, and misdiagnosis were collected. Univariate and logistic regression analysis were used for identification of the independent associated factors. RESULTS The study consisted of 106 children. The boys-to-girls ratio was 2.2:1, and their mean age was 44.65 months ± 30.50 months. The common manifestations were refusal to walk, tenderness, and swelling at the lower extremities. Four participants had unusual manifestations including proptosis and scalp hematoma. Low serum vitamin C level and abnormal radiologic findings were detected in most patients. All of them fully recovered after receiving vitamin C supplementation. Misdiagnosis was identified in 74 cases (69%). Logistic regression analysis revealed that temperature higher than or equal to 38 °C, participants aged 3 years or below, and swelling at lower extremities were independently associated with misdiagnosis (adjusted OR 5.91, 3.78, and 3.56 respectively). CONCLUSIONS Scurvy still exists, and misdiagnosis often occurs. Taking a careful medical history and conducting a physical examination are still the best way to diagnose scurvy.
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Affiliation(s)
- Orawan Iamopas
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
| | - Suntaree Ratanachu-Ek
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
| | - Suranat Kaewnimee
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
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42
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Chou BW, Rivera QN, Francis CE. Spontaneous retrobulbar hemorrhage in the setting of warfarin therapy and latent scurvy diagnosis. Orbit 2021; 41:127-129. [PMID: 34913816 DOI: 10.1080/01676830.2021.2012204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a case of spontaneous nontraumatic retrobulbar hemorrhage associated with anti-coagulation therapy and a new diagnosis of scurvy. A 68-year-old male on chronic anti-coagulation therapy presented with a retrobulbar hemorrhage requiring urgent canthotomy and cantholysis. Despite the absence of a supratherapeutic INR and normal clotting factors, the patient continued to have spontaneous hemorrhages within the orbit and elsewhere. Workup revealed a severe vitamin C deficiency consistent with scurvy. Further investigation of dietary history demonstrated an avoidance of all citrus fruit upon starting warfarin due to misunderstanding in medication counseling on avoidance of grapefruit. With repletion of vitamin C and further medication counseling, the patient had no further episodes of spontaneous hemorrhage.
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Affiliation(s)
- Brian W Chou
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Quinn N Rivera
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Courtney E Francis
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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43
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Moya-Martínez C, Haya-Martínez L, Fuertes-Vega L, Santonja C, Requena L. Co-occurring features of scurvy and phrynoderma in the same patient. JAAD Case Rep 2021; 19:14-17. [PMID: 34901361 PMCID: PMC8640163 DOI: 10.1016/j.jdcr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Lara Haya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Fuertes-Vega
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Santonja
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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44
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Abstract
A 12-year-old boy was admitted to the paediatric ward with a 4-month history of worsening pain and bruising to his legs, which had resulted in a progressive reduction in his mobility. He initially had had difficulty weight bearing, which had then progressed further making him wheelchair bound. On examination, there was extensive bruising (figure 1) to his oedematous legs, worse on his right leg compared with his left. His background of autism and 15q13.3 deletion, along with maternal learning difficulties, made deciphering a clear history difficult. However, there was no account of trauma, and he had been afebrile throughout his illness. He had though lost 6 kg in weight but remained clinically stable. He was admitted to the ward for further assessment.
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Affiliation(s)
- Emma Bailey
- Department of Paediatrics, Lister Hospital, Stevenage, UK
| | - Alaa Ali
- Department of Paediatrics, Lister Hospital, Stevenage, UK
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45
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Murphree J, Mulherin DW, Morton C, Adams D. High-dose vitamin C therapy for symptomatic deficiency in a patient with myasthenia gravis and Crohn's disease. Nutr Clin Pract 2021; 37:1242-1245. [PMID: 34784069 DOI: 10.1002/ncp.10800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vitamin C (ascorbic acid) is an essential water-soluble antioxidant, and deficiency (ie, plasma level <11 μmol/L) can result in scurvy. People at the highest risk for vitamin C deficiency (ie, scurvy) are those with inadequate intake, such as patients with alcohol abuse disorder, malnutrition, psychiatric disorders, restrictive eating habits, and food insecurity, as well as those with malabsorptive syndromes. We present a case of a 26-year-old woman with Crohn's colitis, myasthenia gravis, and juvenile rheumatoid arthritis who presented with frequent bruising, epistaxis, and excessive bleeding from small cuts and who was found to be deficient in vitamin C. Plasma levels initially normalized with oral vitamin C supplementation, but bleeding symptoms eventually returned despite high-dose oral supplementation with 2000 mg daily. She ultimately required routine intravenous supplementation in the home setting for the normalization of levels and the resolution of symptoms. Case reports of vitamin C deficiency typically involve patients with an inadequate intake of vitamin C-containing foods or inadequate absorption. In contrast, our patient reported a regular intake of vitamin C-containing foods, in addition to oral supplementation, but continued to have difficulty maintaining normal vitamin C levels. Scurvy should be considered for any patient with symptoms of bleeding, petechiae, or ecchymosis and, although it can typically be treated with oral vitamin C, intravenous repletion may be necessary in some cases.
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Affiliation(s)
- Jill Murphree
- Nutrition Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diana Wells Mulherin
- Clinical Pharmacy Specialist, Pharmacy Clinical Programs, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colleen Morton
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dawn Adams
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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46
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Shin PW, Gonzales AM, Pham CM, Gajjar T. Scurvy in a patient with a restrictive diet. Proc AMIA Symp 2021; 34:742-743. [PMID: 34733009 DOI: 10.1080/08998280.2021.1951072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Scurvy is a historically significant disease whose incidence has declined significantly with advancements in nutrition and access to varied foods. It is classically characterized by gingival bleeding, corkscrew hairs, and petechiae. In cases of severe deficiency, as seen in patients with years of a restricted diet, impaired connective tissue formation can lead to symptomatic, life-threatening bleeding diathesis. Risk factors for a restrictive diet in patients with unidentified bleeding diathesis should be recognized early to prevent significant morbidity.
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Affiliation(s)
- Patrick W Shin
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
| | - Adrienne M Gonzales
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
| | - Christie M Pham
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
| | - Tapas Gajjar
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
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47
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Ben Ahmed S, Mezghani F, Rhayem S, Fedhila F, Hadded S. Scurvy still exists in children: A case report. Tunis Med 2021; 99:1093-1096. [PMID: 35288913 PMCID: PMC9390125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Scurvy is one of the oldest diseases known to mankind. Although rare lately, the clinical suspicion arises in front of a precarious situation or deficient nutrition and food restriction secondary to a psychiatric condition, even in patients with non-specific complaints. We report the observation of a 6 -year- old boy, followed for autism since the age of 3 years and who was admitted for limping, hemorrhagic syndrome, arthritis and weakness. The diagnosis of child abuse was initially suspected but clinical and radiological abnormalities seen were characteristic of scurvy. Vitamin C level was undetectable. The child had an unbalanced diet.A favorable outcome was rapidly obtained following supplementation. Scurvy is rare, but it should be mentioned among children with psychiatric disorders, presenting with musculoskeletal manifestations or hemorrhagic syndrome. It is essential to prevent it by systematic dietary supplementation of vitamin C in children with eating difficulties.
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Affiliation(s)
- Sarra Ben Ahmed
- Hôpital d’enfants Béchir Hamza de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar
| | - Fatma Mezghani
- Hôpital d’enfants Béchir Hamza de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar
| | - Samar Rhayem
- Hôpital d’enfants Béchir Hamza de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar
| | - Faten Fedhila
- Hôpital d’enfants Béchir Hamza de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar
| | - Samir Hadded
- Hôpital d’enfants Béchir Hamza de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar
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48
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Kow RY, Nik Abdul Adel NA, Abdul Razak AH, Low CL, Awang MS. Scurvy: A Neglected Cause of Muscle Pain and Weakness in a Child With Picky Eating Behavior. Cureus 2021; 13:e16289. [PMID: 34405060 PMCID: PMC8352794 DOI: 10.7759/cureus.16289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
Ascorbic acid (vitamin C) is an essential micronutrient that the human's body cannot synthesize endogenously. Scurvy, a disease of ascorbic acid deficiency, can manifest in a myriad of presentations. Due to its rarity in the modern world, scurvy is considered as a disease of the past. We present a paediatric case of scurvy with musculoskeletal manifestations as a result of picky eating behavior. We report a previously healthy nine-year-old boy who presented with unexplained progressive bilateral lower limb generalized weakness and pain for two months. All initial biochemical and radiological investigations were unremarkable. Upon further history taking, he had severe picky eating behavior which raised the suspicion of scurvy. The diagnosis was confirmed with a serum ascorbic acid test. After ascorbic acid supplementation, his symptoms resolved immediately. Further food behavioral modification counselling to his family members helped to change his diet in a lasting way. As a result, he had no recurrence of symptoms. This case highlights the importance of having a high index of suspicion for an uncommon disease and emphasizes the need for a detailed dietary history upon patient’s presentation.
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Affiliation(s)
- Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Nik Alyani Nik Abdul Adel
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Ardilla Hanim Abdul Razak
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Mohd Shukrimi Awang
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
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49
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Mullie P, Deliens T, Clarys P. Vitamin C in East-Greenland traditional nutrition: a reanalysis of the Høygaard nutritional data (1936-1937). Int J Circumpolar Health 2021; 80:1951471. [PMID: 34232845 PMCID: PMC8266228 DOI: 10.1080/22423982.2021.1951471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Greenlandic traditional nutrition was an almost exclusive meat dietary pattern. Høygaard et al. stayed in East-Greenland between August 1936 and August 1937. The four members of the expedition resided in Tasisaq and recorded nutritional intake by residing in families. However, data were analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards. In total 21 males and 14 females participated. Median (IQR) vitamin C intake was 79 (77) mg.day−1 for males and 59 (56) mg.day−1 for females. Consumption of meat and organs from seals gave 21 mg.d−1 vitamin C, comparable to vitamin C from algae. Narwhal skin and eyes had a marginal contribution to the vitamin C consumption. The number of adults consuming algae during the research days was 67% for males and 71% for females, this was 24% and 21% for narwhal skin. The main conclusions of the present study are the important role of algae consumption in Greenlandic traditional dietary pattern to avoid scurvy, and that foods traditionally seen as important sources of vitamin C like eyes from seals and narwhal skin, played a minor role in meeting the vitamin C requirements.
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Affiliation(s)
- Patrick Mullie
- Belgian Defence, Military Performance Amplification Research Center, Evere, Belgium.,Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Elsene, Belgium
| | - Tom Deliens
- Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Elsene, Belgium
| | - Peter Clarys
- Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Elsene, Belgium
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50
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Abstract
Significance: Humans cannot synthesize ascorbic acid (AscH2) (vitamin C), so deficiencies in dietary AscH2 cause the life-threatening disease of scurvy and many other diseases. After oral ingestion, plasma AscH2 concentrations are strictly controlled by transporters, which are required for entry into the cell and into intracellular organelles. Recent Advances: Besides its general antioxidant function, AscH2 is a cofactor for endoplasmic reticulum (ER)-localized collagen hydroxylases. Its important role in ER homeostasis is also highlighted by the fact that AscH2 deficiency in auxotrophic species triggers ER stress. Critical Issues: Characterizations of the molecular basis of diseases suggest that intracellular AscH2 deficiency is due not only to limited dietary access but also to its limited intracellular transport and net loss under conditions of intracellular hyperoxidation in the ER. This essay will offer an overview of the different transporters of vitamin C regulating its intracellular concentration, its function inside the ER, and the phenotypes of the diseases that can be triggered by increased depletion of this vitamin in the ER. Future Directions: When considering the benefits of increasing dietary AscH2, it is important to consider pharmacokinetic differences in the bioavailability between orally and intravenously administered AscH2: the latter bypasses intestinal absorption and is, therefore, the only route that can lead to the high plasma concentrations that may provide some health effects, and it is this route that needs to be chosen in clinical trials for those diseases associated with a deficiency of AscH2. Antioxid. Redox Signal. 34, 845-855.
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Affiliation(s)
- Diego Pozzer
- Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Milan, Italy
| | | | - Bert Blaauw
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- Venetian Institute of Molecular Medicine, Padua, Italy
| | - Orazio Cantoni
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Ester Zito
- Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Milan, Italy
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